OVERVIEW

What is vitiligo?

Vitiligo, also known as leukoderma, is a common skin disease with huge social impact in our countryin which white spots or patches appear on the skin. These spots are caused by destruction or weakening of the pigment cells in those areas, resulting in the pigment being destroyed or no longer produced.

Vitiligo is non-contagious means it doesn’t spread by touch or sharing food or other things. As we indians have wheatish to dark brown skin complexion so loss of color make lekoderma more visible.Although it is just a loss of color at some areas of body but it may have a negative psychological effect on confidence of the patient. It has been considered as social stigma but awareness with time is helping people to overcome from these thoughts.

CAUSES

The causes of vitiligo are still unknown.There are multiple theories which are considered as cause of Vitiligo.

• Autoimmune,
• Oxidative stress (excess of hydrogen peroxide),
• Neurotrophic (interaction of melanocytes and the nervous system)
• Genetic or family history

Triggering or exacerbating factors:

• Stress,
• Traumatic injury
• Burn or sunburns,
• Exposure to Chemicals (chemical leukoderma)- bindi, chandan teeka, rubber chappal.
• Vitiligo patients are predisposed to develop other autoimmune diseases like thyroid disorders (especially hypothyroidism), alopecia areata, diabetes, pernicious anaemia.

SYMPTOMS

How does vitiligo present?

People who develop vitiligo usually first notice white patches or spots (depigmentation) on their skin with or without white hairs. The skin remains of normal texture. Gradually white spots appear and may spread on different parts of body. The white patches are more obvious in sun-exposed areas, including the hands, feet, arms, legs face, and lips but other areas may be involved.Vitiligo generally appears in one of three patterns;

Focal vitiligo- the depigmentation is limited to one or only a few areas, for example if white spots are present only on hands and feet it is called acral vitiligo, if only on face (facial ), if both areas involved it is called acrofacial vitiligo and if inside mouth, nose or genital white spots develop it is called mucosal vitiligo.

Segental vitiligo- depigmented patches on only one side of their bodies,

Vitiligo Vulgaris- depigmentation occurs on different parts of the body and usually progress symmetrically on corresponding body parts.

What is the course and severity of vitiligo ?

The course and severity of pigment loss differ with each person. In many cases, vitiligo begins in a small area. Over time, other spots may appear, while existing spots may grow larger. Some people notice that their vitiligo may stay the same for years or even decades, and then suddenly new areas of depigmentation may occur. Occasionally, vitiligo patches will repigment spontaneously, all by themselves, with no treatment whatsoever.

TREATMENT

Diagnosis

Most of the time only detailed history about evolution of white patch and examination are suffice to make diagnosis. In doubtful cases observation, woods lamp examination and biopsy help in making confirm diagnosis.

What are the treatment options for vitiligo in Jaipur?

The Vitiligo treatment in Jaipur aims to even out the skin colour and improve the appearance of skin.Treatment options for vitiligo are:

Phototherapy (first line of treatment) or Photochemotherapy

• Photochemotherapy: Here psoralens (substances which make skin more sensitive to light therapy) are applied on skin or taken through mouth followed by exposing the affected skin by UVA and UVB rays. This has to be repeated 2-3 times a week for 6-12 months.
• Phototherapy (Narrowband UVB phototherapy): These are closed chambers where patient need to stand for 10-15 minutes 2-3 times in week and white spots will be exposed to light having specific spectrum (310-312 nm) of UVB light. It is most effective treatment modality for bringing back the color of skin.
• Excimer Laser for vitiligo: It is useful for small and focal lesions. Repigmentation is little faster than phototherapy.

Medical Treatment (if disease active): It consists of

• Cortico steroids: Application of steroid creams, may help restore skin color to certain extent, though changes are slow, and medications must be used regularly. Oral steroids can be given to stop new white spots.
• Immune system modulators: Calcineurin inhibitors can help to regain colour in some areas of depigmentation especially in face and neck. Non steroidal immunosuppresives can be used to stop oral steroids and for giving long term control on disease activity.

Vitiligo Surgery (require 1 year of disease stability)

Surgical techniques can also be used to restore skin tone. Various modalities which can be used are as follows:

• Punch grafting: This procedure involves, removing small areas of normal, pigmented skin and grafting them to areas with loss of pigmentation.
• Suction Blister Grafting: Here blisters are created on the pigmented skin with help of vacuum and uppermost layer of the blister is then transplanted to the depigmented skin
• Non cultured epidermal cell suspension: here dermatologist remove thin graft from skin and separates epidermal cells from graft with help of laboratory devices. Then it is transplanted to white spots.

Micropigmentation: In this procedure, pigment is implanted on the affected skin to match the rest of the skin colour. Especially used around lips and face. It is useful for small lesions.
Camouflage: There are many providers for skin colors who give multiple options of color and you can use it for important social gathering or ocassions. It lasts for 6-8 hours.
Depigmentation treatment: This can be used if color of skin has lost from almost all over body and only few patches of normal skin left over. Here a depigmentation agent is applied on unaffected areas, which lightens the skin tone and help it blend with affected skin.

How dermatologist may decide treatment for vitiligo?

Vitiligo treatment depends on severity, activity and extent of white patches.

Why Dr Kothiwala SkinEva Clinic is best clinic for treatment of vitiligo or leukoderma?

• Detailed consultation with best dermatologist in Jaipur Dr. Sunil Kothiwala.
• We run speciality clinic for Vitiligo on particular day once in a week.
• AIIMS protocol of treatment of vitiligo.Scenario 1 (Stable disease, no new patches) – phototherapy is treatment of choice.
  Scenario 2 (active disease, rapidly progressive)- phototherapy and oral and topical immunosuppressive agents
  Scenario 3 ( stable disease since at least 1 year , not responding to any modality) – Vitiligo surgery followed by phototherapy
• Availability of Phototherapy – Narrowband UVB phototherapy for vitiligo in Jaipur
• Availability of world’s best Alma’s Excimer Laser treatment for vitiligo in Jaipur
• Dr Sunil Kothiwala is providing excellent results by doing all types of vitiligo surgery in Jaipur.

For more information on Vitiligo treatment in Vaishali Nagar and Sitabadi Tonk Road branches or to inquire about other services please contact us on 7726938335

TIPS

1. Have a healthy life style.
2. When you have doubtful lesion, take photographs in every 7 days and check thoroughly whole body.
3. If lesions are increasing in number, don’t ignore it and visit dermatologist as as soon as possible.
4. Discuss about disease in detail with dermatologist.
5. Follow treatment sincerely, inform doctor about any query coming to your mind during treatment.
6. Keep your mood and confidece high and talk about it with your dermatologist frankly.

FAQs

• Q.How do I find a doctor that treats vitiligo?
• A. For treatment of vitiligo, you can contact a doctor who is postgraduate in dermatology (MD, DNB, DVD). You can visit a government medical institutes which have dedicated department for treatment of skin diseases or private clinics run by qualified dermatologists. Don’t be hesitate to ask your doctor if his office uses specific therapies, such as Narrow Band UVB, Vitiligo Surgeries according to your disease status.

• Q.My father have vitiligo since his age of 30s. Am I susceptible to get vitiligo? Is it possible to get vitiligo even if nobody in family is having it?
• A. Yes, in about 12% of families where a person has vitiligo, the condition is seen in another family member. Though no one else in your family may show signs of vitiligo, it is still possible that it is passed on genetically. The most likely reason for this is that more than one gene is responsible for the development of vitiligo.

• Q.Will the vitiligo patches spread over time? Will they get larger?
• A. In many, but certainly not all cases, vitiligo does progress slowly over time, but there is really no way to tell whether your vitiligo will progress or not. Many patients report that they may go many years without new patches developing, and then may discover new patches appearing years later. Some people even report spots that spontaneously repigment, with no treatment at all.

• Q.I have few white patches. Can my child get it by frequently touching and scratching lesions?
• A. Vitiligo is NOT contagious. There is no need to be cautious as it does not spread by touch or frequent contact.

• Q.Are there things that a person with vitiligo should avoid?
• A. If you are susceptible to develop white patches with exposure to certain chemicals (phenolic compounds) then you should avoid them. Many times few patients develop new patches at site of trauma so in that case you should avoid minor trauma. There is not enough consistent scientific evidence to prove how a particular food item adversely affect vitiligo so there is no dietary restriction. Most important, avoid self-medication.

• Q.I was told vitiligo could not be treated. Is that correct?
• A. Vitiligo is difficult to treat – that much is true. But in the past few years, new treatments have been developed that are working better. And there are more options. Vitiligo can be treated, though results can take time. Even though treatment can take from 6 months up to two years or longer to see results, there are many new treatments available. Where you don’t see good results with one treatment, another may work better.

• Q.How long does it take to treat vitiligo? When should I expect results? Are the treatments needed to be done forever?
• A. Results from the treatments available vary by person. Some people will see results from treatment within 3 to 6 months. With immunomodulators, some people are reporting some repigmentation with 4 to 8 weeks. The rule of thumb, is that you will need to allow at least 3 to 6 months before you begin to see results from ANY treatment. Additionally, you should expect to treat for up to two years or longer, in order to see good results. If you try a treatment for 3 months, and then quit because you saw no results, you did not wait long enough. As it is an autoimmune disease with genetic impact, it may recur anytime which depends on many factors. Whenever it recurs, treatment is needed. If your patches resolved, treatment can be stopped.

• Q.Are there any natural remedies for vitiligo?
• A. Evening primrose oil, Aloe Vera and papaya are found to be useful. But these treatment are minimal effective. They can be tried if disease is stable.

• Q.Are there parts of the body that are harder to treat than others?
• A. For some reason, certain parts of their body, including the hands, feet, and some areas where the hair has turned white, do seem to be harder to treat than other areas. After sufficient medical treatment such resistant lesions may require vitiligo surgeries.

• Q.People stare at my spots. I am embarrassed by my vitiligo. Is there anything I can do?
• A. In the old days, many people used to take vitiligo as social stigma. But people are becoming more aware about vitiligo, and it seems that almost everyone knows someone with the condition. Still, to some people, vitiligo is unusual, and is god’s wish. Do not be afraid to tell people what it is, especially family members and friends. You explain that vitiligo is an autoimmune condition which is not contagious. You should try to maintain a normal lifestyle.

• Q.Are there any cosmetics available to cover-up Vitiligo spots?
• A. Nowadays, a number of camouflage creams are available which can be selected and applied over vitiligo patches to match the patient’s natural skin colour as closely as possible for temporary purpose.

• Q.I have vitiligo since 7-8 years. I have taken many treatments including ayurvedic, homeopathic and allopathic. My lesions over lip and feet have not responded to any of it. They are static since 2-3 years. Am I suitable candidate for vitiligo surgeries?
• A. Yes, for any patch which is stable since 1 year suitable for surgical treatment. Although lesions over lip and bony areas are poorly responding.

• Q.What are vitiligo surgeries? Do they have any downtime or risk?
• A. Vitiligo surgeries are based on transplantation of skin containing pigment cells (punch grafting, suction blister grafting) or epidermal cells ( non cultured epidermal cell suspension) from non involved area to involved area. After these surgeries you can do your all basic needful activities. You will need phototherapy after grafting surgeries to induce maximum repigmentation. Results of vitiligo surgeries done by experienced dermato surgeons are excellent. There is no serious risk during or post vitiligo surgeries.

For more information on Vitiligo Treatment in Vaishali Nagar, Jaipur or to inquire about other services please contact us on 7669571405.